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Chuah SH, Tan LK, Md Sari NA, Chan BT, Hasikin K, Lim E, Ung NM, Abdul Aziz YF, Jayabalan J, Liew YM. Remodeling in Aortic Stenosis With Reduced and Preserved Ejection Fraction: Insight on Motion Abnormality Via 3D + Time Personalized LV Modeling in Cardiac MRI. J Magn Reson Imaging 2024; 59:1242-1255. [PMID: 37452574 DOI: 10.1002/jmri.28915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Increased afterload in aortic stenosis (AS) induces left ventricle (LV) remodeling to preserve a normal ejection fraction. This compensatory response can become maladaptive and manifest with motion abnormality. It is a clinical challenge to identify contractile and relaxation dysfunction during early subclinical stage to prevent irreversible deterioration. PURPOSE To evaluate the changes of regional wall dynamics in 3D + time domain as remodeling progresses in AS. STUDY TYPE Retrospective. POPULATION A total of 31 AS patients with reduced and preserved ejection fraction (14 AS_rEF: 7 male, 66.5 [7.8] years old; 17 AS_pEF: 12 male, 67.0 [6.0] years old) and 15 healthy (6 male, 61.0 [7.0] years old). FIELD STRENGTH/SEQUENCE 1.5 T Magnetic resonance imaging/steady state free precession and late-gadolinium enhancement sequences. ASSESSMENT Individual LV models were reconstructed in 3D + time domain and motion metrics including wall thickening (TI), dyssynchrony index (DI), contraction rate (CR), and relaxation rate (RR) were automatically extracted and associated with the presence of scarring and remodeling. STATISTICAL TESTS Shapiro-Wilk: data normality; Kruskal-Wallis: significant difference (P < 0.05); ICC and CV: variability; Mann-Whitney: effect size. RESULTS AS_rEF group shows distinct deterioration of cardiac motions compared to AS_pEF and healthy groups (TIAS_rEF : 0.92 [0.85] mm, TIAS_pEF : 5.13 [1.99] mm, TIhealthy : 3.61 [1.09] mm, ES: 0.48-0.83; DIAS_rEF : 17.11 [7.89]%, DIAS_pEF : 6.39 [4.04]%, DIhealthy : 5.71 [1.87]%, ES: 0.32-0.85; CRAS_rEF : 8.69 [6.11] mm/second, CRAS_pEF : 16.48 [6.70] mm/second, CRhealthy : 10.82 [4.57] mm/second, ES: 0.29-0.60; RRAS_rEF : 8.45 [4.84] mm/second; RRAS_pEF : 13.49 [8.56] mm/second, RRhealthy : 9.31 [2.48] mm/second, ES: 0.14-0.43). The difference in the motion metrics between healthy and AS_pEF groups were insignificant (P-value = 0.16-0.72). AS_rEF group was dominated by eccentric hypertrophy (47.1%) with concomitant scarring. Conversely, AS_pEF group was dominated by concentric remodeling and hypertrophy (71.4%), which could demonstrate hyperkinesia with slight wall dyssynchrony than healthy. Dysfunction of LV mechanics corresponded to the presence of myocardial scarring (54.9% in AS), which reverted the compensatory mechanisms initiated and performed by LV remodeling. DATA CONCLUSION The proposed 3D + time modeling technique may distinguish regional motion abnormalities between AS_pEF, AS_rEF, and healthy cohorts, aiding clinical diagnosis and monitoring of AS progression. Subclinical myocardial dysfunction is evident in early AS despite of normal EF. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Shoon Hui Chuah
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nor Ashikin Md Sari
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Malaysia
| | - Khairunnisa Hasikin
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ngie Min Ung
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jeyaraaj Jayabalan
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
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Ding CCA, Dokos S, Bakir AA, Zamberi NJ, Liew YM, Chan BT, Md Sari NA, Avolio A, Lim E. Simulating impaired left ventricular-arterial coupling in aging and disease: a systematic review. Biomed Eng Online 2024; 23:24. [PMID: 38388416 PMCID: PMC10885508 DOI: 10.1186/s12938-024-01206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
Aortic stenosis, hypertension, and left ventricular hypertrophy often coexist in the elderly, causing a detrimental mismatch in coupling between the heart and vasculature known as ventricular-vascular (VA) coupling. Impaired left VA coupling, a critical aspect of cardiovascular dysfunction in aging and disease, poses significant challenges for optimal cardiovascular performance. This systematic review aims to assess the impact of simulating and studying this coupling through computational models. By conducting a comprehensive analysis of 34 relevant articles obtained from esteemed databases such as Web of Science, Scopus, and PubMed until July 14, 2022, we explore various modeling techniques and simulation approaches employed to unravel the complex mechanisms underlying this impairment. Our review highlights the essential role of computational models in providing detailed insights beyond clinical observations, enabling a deeper understanding of the cardiovascular system. By elucidating the existing models of the heart (3D, 2D, and 0D), cardiac valves, and blood vessels (3D, 1D, and 0D), as well as discussing mechanical boundary conditions, model parameterization and validation, coupling approaches, computer resources and diverse applications, we establish a comprehensive overview of the field. The descriptions as well as the pros and cons on the choices of different dimensionality in heart, valve, and circulation are provided. Crucially, we emphasize the significance of evaluating heart-vessel interaction in pathological conditions and propose future research directions, such as the development of fully coupled personalized multidimensional models, integration of deep learning techniques, and comprehensive assessment of confounding effects on biomarkers.
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Affiliation(s)
- Corina Cheng Ai Ding
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Azam Ahmad Bakir
- University of Southampton Malaysia Campus, 79200, Iskandar Puteri, Johor, Malaysia
| | - Nurul Jannah Zamberi
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500, Selangor, Malaysia
| | - Nor Ashikin Md Sari
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Alberto Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Ibrahim DFA, Hasmun NN, Liew YM, Venkiteswaran A. Effects of repeated etching cycles using 15% hydrochloric acid on enamel loss and relative attenuation coefficient in resin infiltration. Photodiagnosis Photodyn Ther 2024; 45:103989. [PMID: 38280674 DOI: 10.1016/j.pdpdt.2024.103989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/14/2023] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Resin infiltration is used to mask enamel opacities and the recommended etching cycles are three. However, anecdotal evidence suggests that favorable esthetics outcomes can be obtained by increasing the etching cycles. AIM To determine the incremental and total enamel loss when enamel surfaces are exposed to multiple etching cycles and to assess the relative attenuation coefficient after multiple etching cycles and resin infiltration treatment. METHODS Ninety extracted sound human premolars teeth were divided into 9 groups (n = 10); with each consecutive group having one additional etching cycle up to 9 cycles. The teeth were scanned with optical coherence tomography and enamel loss and attenuation coefficient were measured with MATLAB software. Enamel loss (one-way ANOVA, p ≤ 0.05) and attenuation coefficient (two-way ANOVA, p ≤ 0.05) were statistically analyzed. RESULTS There was a significant total enamel loss of more than 33% found at the 7th etching cycle and more. There was no statistically significant difference in the incremental mean depth of penetration of resin between various etching cycles (F(8, 134) = [2.016], one-way ANOVA, p = 0.185). CONCLUSION This study recommends that etching should not be repeated more than seven cycles to prevent excessive enamel loss. Following eight etching cycles, resin infiltration penetration appears approximately equal to that of healthy enamel.
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Affiliation(s)
- Dayang Fadzlina Abang Ibrahim
- Paediatric Dental Specialist Clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia; Centre of Paediatric Dentistry and Orthodontics Studies, Faculty of Dentistry, Universiti Teknologi MARA, 47000 Sungai Buloh, Selangor, Malaysia
| | - Noren Nor Hasmun
- Department of Oral Science, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Wilayah 50603, Persekutuan Kuala Lumpur, Malaysia
| | - Annapurny Venkiteswaran
- Centre of Paediatric Dentistry and Orthodontics Studies, Faculty of Dentistry, Universiti Teknologi MARA, 47000 Sungai Buloh, Selangor, Malaysia.
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Chuah SH, Md Sari NA, Tan LK, Chiam YK, Chan BT, Abdul Aziz YF, Jeyabalan J, Hasikin K, Liew YM. Assessing Complex Left Ventricular Adaptations in Aortic Stenosis Using Personalized 3D + time Cardiac MRI Modeling. J Cardiovasc Transl Res 2023; 16:1110-1122. [PMID: 37022611 DOI: 10.1007/s12265-023-10375-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/09/2023] [Indexed: 04/07/2023]
Abstract
Left ventricular adaptations can be a complex process under the influence of aortic stenosis (AS) and comorbidities. This study proposed and assessed the feasibility of using a motion-corrected personalized 3D + time LV modeling technique to evaluate the adaptive and maladaptive LV response to aid treatment decision-making. A total of 22 AS patients were analyzed and compared against 10 healthy subjects. The 3D + time analysis showed a highly distinct and personalized pattern of remodeling in individual AS patients which is associated with comorbidities and fibrosis. Patients with AS alone showed better wall thickening and synchrony than those comorbid with hypertension. Ischemic heart disease in AS caused impaired wall thickening and synchrony and systolic function. Apart from showing significant correlations to echocardiography and clinical MRI measurements (r: 0.70-0.95; p < 0.01), the proposed technique helped in detecting subclinical and subtle LV dysfunction, providing a better approach to evaluate AS patients for specific treatment, surgical planning, and follow-up recovery.
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Affiliation(s)
- Shoon Hui Chuah
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nor Ashikin Md Sari
- Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
- University Malaya Research Imaging Centre, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yin Kia Chiam
- Department of Software Engineering, Faculty of Computer Science and Information Technology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, 43500, Semenyih, Malaysia
| | - Yang Faridah Abdul Aziz
- University Malaya Research Imaging Centre, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Jeyaraaj Jeyabalan
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Khairunnisa Hasikin
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Saberi FNM, Liew YM, Sukumaran P, Ung NM. Ex-vivo analysis of demineralisation on irradiated teeth using optical coherence tomography. Photodiagnosis Photodyn Ther 2023; 43:103715. [PMID: 37481146 DOI: 10.1016/j.pdpdt.2023.103715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
Head and neck cancer patients are prone to dental caries after radiotherapy. An ex-vivo study was conducted to assess the feasibility of optical coherence tomography (OCT) to detect tooth demineralization due to caries in irradiated teeth. Thirty-nine human molar teeth were subjected to caries lesion induction through irradiation (Group 1), pH cycling (Group 2-1), and both (Group 2-2). The OCT signal attenuation coefficient, µR was assessed and validated against microhardness test and scanning electron microscope (SEM). The µR for Group 1 increased from 10 Gy to 40 Gy, and subsequently decreased after irradiated to 50 Gy and 60 Gy due to damaged enamel microstructure. In Group 2-1, the µR decreased with duration of pH cycling from day 1 to day 14 due to the increase of porosity in enamel layer. However, the µR showed decreasing trend from day 14 to day 28 of pH cycling, resulted from mineral deposition in the enamel layer. Although no significant difference was found in the µR between Group 2-1 and 2-2, SEM of Group 2-2 demonstrated visually higher porosity and larger gaps between microstructures. Irradiation may accelerate caries damage to tooth microstructure by increasing its porosity and brittleness, but larger sample size may be needed to further prove the effect. OCT could potentially be used for early detection of tooth demineralization in vivo based on the measurable µR changes for all groups which are shown negatively correlated with microhardness value (p < 0.05).
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Affiliation(s)
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Prema Sukumaran
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom.
| | - Ngie Min Ung
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Ibrahim DFA, Hasmun NN, Liew YM, Venkiteswaran A. Repeated Etching Cycles of Resin Infiltration up to Nine Cycles on Demineralized Enamel: Surface Roughness and Esthetic Outcomes-In Vitro Study. Children (Basel) 2023; 10:1148. [PMID: 37508644 PMCID: PMC10378243 DOI: 10.3390/children10071148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023]
Abstract
Resin infiltration (RI) is used to mask enamel opacities. There are three recommended etching cycles. However, anecdotal evidence suggests that favorable esthetics outcomes can be obtained by increasing the etching cycles. This study aimed to evaluate the effects of repeated etching cycles during RI application on esthetic changes and surface roughness of demineralized enamel at multiple treatment stages. Artificial demineralization was prepared on the buccal surface of ninety sound extracted premolars. The teeth were divided into nine groups (n = 10); with each consecutive group having one additional etching cycle up to nine etching cycles. Resin infiltrant was performed twice, first for 3 min (Resin 1) and again for 1 min (Resin 2). Surface roughness and esthetic changes were assessed using a profilometer (Ambios XP-200) and Minolta spectrophotometer, respectively, at baseline (sound enamel), etching, resin 1, resin 2, 7 days, and 28 days post resin applications. Data were analyzed with two-way ANOVA (p < 0.05). There was a significant interaction between the different stages and various groups of etching cycles on surface roughness, F(48, 126) = 3.48, p < 0.001. There was a significant interaction between the different stages and various groups of etching cycles on color changes, F(4, 126) = 1.177, p = 0.045. The surface roughness of demineralized enamel infiltrated with RI was less than that of sound enamel (baseline). There is a significant difference in color changes between resin 1 and resin 2 (p < 0.05). After five etching cycles, RI improved the esthetic of the color of teeth similar to the baseline. Surface roughness and color changes remained constant for 28 days. RI can be considered an effective and predictable treatment option for the restoration of early enamel lesions owing to its better surface characteristics and reliable masking effects. The color stability and surface roughness stay unaltered for up to 28 days.
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Affiliation(s)
- Dayang Fadzlina Abang Ibrahim
- Centre of Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Campus Sungai Buloh, Sungai Buloh 47000, Malaysia
| | - Noren Nor Hasmun
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Annapurny Venkiteswaran
- Centre of Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Campus Sungai Buloh, Sungai Buloh 47000, Malaysia
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Zahir NSM, Saad M, Alip A, Rejab M, Jamalludin Z, Hizam NDA, Liew YM, Ung NM. Evaluation of intrafractional prostate displacement during prostate radiotherapy using real-time ultrasound system. Phys Eng Sci Med 2023; 46:405-412. [PMID: 36806157 DOI: 10.1007/s13246-023-01230-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
Transperineal ultrasound (TPUS) is an image-guided radiotherapy system used for tracking intrafraction prostate displacements in real time. The objectives of this study are to evaluate intrafraction prostate displacements and derive planning target volume (PTV) margins for prostate radiotherapy at our institution. The ultrasound (US) data of nine prostate cancer patients referred for VMAT radiotherapy was retrieved. Prior to beam on, patient position was set up with the US probe positioned transperineally with the aid of reference images (fused US and computed tomography images). In each fraction, prostate displacements in three directions [superior/inferior (SI), left/right (LR) and anterior/posterior (AP)] were recorded. PTV margins were determined using Van Herk's formula. To assess the prostate displacement time trend, continuous displacement data were plotted in 30-s intervals for eight minutes. The intrafraction prostate monitoring found a population mean setup error (Mp) of 0.8, 0.1, - 1.7 mm, a systematic error of (∑p) 0.7, 0.4, 0.9 mm and random error (σp) of 0.2, 0.1, 0.3 mm in SI, LR and AP directions, respectively. The PTV margin was found to be the largest in the AP direction at 2.5 mm compared with 1.9 mm and 1.1 mm for SI and LR directions, respectively. The PTV margin allowed for prostate radiotherapy at our institution was 2.5 mm in all directions. The prostate displacement time trend showed an increase in intrafraction displacements, with most patients were observed to have strong positive correlation between time and intrafraction prostate displacements in SI direction. TPUS is feasible for monitoring intrafraction displacement of the prostate and may facilitate PTV margin generation to account for such displacements during radiotherapy.
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Affiliation(s)
| | - Marniza Saad
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Adlinda Alip
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Munira Rejab
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Medical Physics Unit, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Zulaikha Jamalludin
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ngie Min Ung
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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Mohamad Saberi FN, Sukumaran P, Ung NM, Liew YM. Assessment of demineralized tooth lesions using optical coherence tomography and other state-of-the-art technologies: a review. Biomed Eng Online 2022; 21:83. [PMID: 36463182 PMCID: PMC9719651 DOI: 10.1186/s12938-022-01055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
Tooth demineralization is one of the most common intraoral diseases, encompassing (1) caries caused by acid-producing bacteria and (2) erosion induced by acid of non-bacterial origin from intrinsic sources (e.g. stomach acid reflux) and extrinsic sources (e.g. carbonated drinks). Current clinical assessment based on visual-tactile examination and standardized scoring systems is insufficient for early detection. A combination of clinical examination and technology is therefore increasingly adapted. This paper reviews various procedures and technologies that have been invented to diagnose and assess the severity of tooth demineralization, with focus on optical coherence tomography (OCT). As a micron-resolution non-invasive 3D imaging modality, variants of OCT are now available, offering many advantages under different working principles for detailed analytical assessment of tooth demineralization. The roles, capabilities and impact of OCT against other state-of-the-art technologies in both clinical and research settings are described. (139 words).
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Affiliation(s)
- Fatin Najwa Mohamad Saberi
- grid.10347.310000 0001 2308 5949Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Prema Sukumaran
- grid.13097.3c0000 0001 2322 6764Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, England
| | - Ngie Min Ung
- grid.10347.310000 0001 2308 5949Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- grid.10347.310000 0001 2308 5949Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
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Md Idris N, Chiam YK, Varathan KD, Wan Ahmad WA, Chee KH, Liew YM. Correction to: Feature selection and risk prediction for patients with coronary artery disease using data mining. Med Biol Eng Comput 2022; 60:887. [PMID: 35048276 DOI: 10.1007/s11517-022-02506-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nashreen Md Idris
- Department of Software Engineering, Faculty of Computer Science and Information Technology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yin Kia Chiam
- Department of Software Engineering, Faculty of Computer Science and Information Technology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Kasturi Dewi Varathan
- Department of Information Systems, Faculty of Computer Science and Information Technology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- Department of Medicine, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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Lau YS, Tan LK, Chan CK, Chee KH, Liew YM. Automated segmentation of metal stent and bioresorbable vascular scaffold in intravascular optical coherence tomography images using deep learning architectures. Phys Med Biol 2021; 66. [PMID: 34911053 DOI: 10.1088/1361-6560/ac4348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/15/2021] [Indexed: 11/11/2022]
Abstract
Percutaneous coronary intervention (PCI) with stent placement is a treatment effective for coronary artery diseases. Intravascular optical coherence tomography (OCT) with high resolution is used clinically to visualize stent deployment and restenosis, facilitating PCI operation and for complication inspection. Automated stent struts segmentation in OCT images is necessary as each pullback of OCT images could contain thousands of stent struts. In this paper, a deep learning framework is proposed and demonstrated for the automated segmentation of two major clinical stent types: metal stents and bioresorbable vascular scaffolds (BVS). U-Net, the current most prominent deep learning network in biomedical segmentation, was implemented for segmentation with cropped input. The architectures of MobileNetV2 and DenseNet121 were also adapted into U-Net for improvement in speed and accuracy. The results suggested that the proposed automated algorithm's segmentation performance approaches the level of independent human obsevers and is feasible for both types of stents despite their distinct appearance. U-Net with DenseNet121 encoder (U-Dense) performed best with Dice's coefficient of 0.86 for BVS segmentation, and precision/recall of 0.92/0.92 for metal stent segmentation under optimal crop window size of 256.
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Affiliation(s)
- Yu Shi Lau
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chow Khuen Chan
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
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Leong CO, Leong CN, Liew YM, Al Abed A, Aziz YFA, Chee KH, Sridhar GS, Dokos S, Lim E. The role of regional myocardial topography post-myocardial infarction on infarct extension. Int J Numer Method Biomed Eng 2021; 37:e3501. [PMID: 34057819 DOI: 10.1002/cnm.3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/26/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
Infarct extension involves necrosis of healthy myocardium in the border zone (BZ), progressively enlarging the infarct zone (IZ) and recruiting the remote zone (RZ) into the BZ, eventually leading to heart failure. The mechanisms underlying infarct extension remain unclear, but myocyte stretching has been suggested as the most likely cause. Using human patient-specific left-ventricular (LV) numerical simulations established from cardiac magnetic resonance imaging (MRI) of myocardial infarction (MI) patients, the correlation between infarct extension and regional mechanics abnormality was investigated by analysing the fibre stress-strain loops (FSSLs). FSSL abnormality was characterised using the directional regional external work (DREW) index, which measures FSSL area and loop direction. Sensitivity studies were also performed to investigate the effect of infarct stiffness on regional myocardial mechanics and potential for infarct extension. We found that infarct extension was correlated to severely abnormal FSSL in the form of counter-clockwise loop at the RZ close to the infarct, as indicated by negative DREW values. In regions demonstrating negative DREW values, we observed substantial fibre stretching in the isovolumic relaxation (IVR) phase accompanied by a reduced rate of systolic shortening. Such stretching in IVR phase in part of the RZ was due to its inability to withstand the high LV pressure that was still present and possibly caused by regional myocardial stiffness inhomogeneity. Further analysis revealed that the occurrence of severely abnormal FSSL due to IVR fibre stretching near the RZ-BZ boundary was due to a large amount of surrounding infarcted tissue, or an excessively stiff IZ.
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Affiliation(s)
- Chen Onn Leong
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Neng Leong
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Amr Al Abed
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Socrates Dokos
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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Tan WT, Liew YM, Mohamed Mokhtarudin MJ, Pirola S, Wan Ab Naim WN, Amry Hashim S, Xu XY, Lim E. Effect of Vessel Tortuosity on Stress Concentration at the Distal Stent-Vessel Interface: Possible Link With New Entry Formation Through Biomechanical Simulation. J Biomech Eng 2021; 143:1105247. [PMID: 33764388 DOI: 10.1115/1.4050642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 12/16/2022]
Abstract
A computational approach is used to investigate potential risk factors for distal stent graft-induced new entry (dSINE) in aortic dissection (AD) patients. Patient-specific simulations were performed based on computed tomography images acquired from six AD patients (three dSINE and three non-dSINE) to analyze the correlation between anatomical characteristics and stress/strain distributions. Sensitivity analysis was carried out using idealized models to independently assess the effect of stent graft length, stent tortuosity and wedge apposition angle at the landing zone on key biomechanical variables. Mismatch of biomechanical properties between the stented and nonstented regions led to high stress at the distal stent graft-vessel interface in all patients, as well as shear strain in the neighboring region, which coincides with the location of tear formation. Stress was observed to increase with the increase of stent tortuosity (from 263 kPa at a tortuosity angle of 50 deg to 313 kPa at 30 deg). It was further amplified by stent graft landing at the inflection point of a curve. Malapposition of the stent graft led to an asymmetrical segment within the aorta, therefore changing the location and magnitude of the maximum von Mises stress substantially (up to +25.9% with a +25 deg change in the distal wedge apposition angle). In conclusion, stent tortuosity and wedge apposition angle serve as important risk predictors for dSINE formation in AD patients.
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Affiliation(s)
- Wei Ting Tan
- Department of Biomedical Engineering, Faculty of Engineering, University Malaya, Kuala Lumpur 50603, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University Malaya, Kuala Lumpur 50603, Malaysia
| | - Mohd Jamil Mohamed Mokhtarudin
- Department of Mechanical Engineering, College of Engineering, Universiti Malaysia Pahang, Gambang, Pahang 26300, Malaysia
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, Imperial College Rd, Kensington, London SW7 2AZ, UK
| | - Wan Naimah Wan Ab Naim
- Faculty of Mechanical and Automotive Engineering Technology, Universiti Malaysia Pahang, Pekan, Pahang 26600, Malaysia
| | - Shahrul Amry Hashim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, Imperial College Rd, Kensington, London SW7 2AZ, UK
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University Malaya, Kuala Lumpur 50603, Malaysia
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13
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Wan Ab Naim WN, Sun Z, Liew YM, Chan BT, Jansen S, Lei J, Ganesan PB, Hashim SA, Sridhar GS, Lim E. Comparison of diametric and volumetric changes in Stanford type B aortic dissection patients in assessing aortic remodeling post-stent graft treatment. Quant Imaging Med Surg 2021; 11:1723-1736. [PMID: 33936960 DOI: 10.21037/qims-20-814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The study aims to analyze the correlation between the maximal diameter (both axial and orthogonal) and volume changes in the true (TL) and false lumens (FL) after stent-grafting for Stanford type B aortic dissection. Method Computed tomography angiography was performed on 13 type B aortic dissection patients before and after procedure, and at 6 and 12 months follow-up. The lumens were divided into three regions: the stented area (Region 1), distal to the stent graft to the celiac artery (Region 2), and between the celiac artery and the iliac bifurcation (Region 3). Changes in aortic morphology were quantified by the increase or decrease of diametric and volumetric percentages from baseline measurements. Results At Region 1, the TL diameter and volume increased (pre-treatment: volume =51.4±41.9 mL, maximal axial diameter =22.4±6.8 mm, maximal orthogonal diameter =21.6±7.2 mm; follow-up: volume =130.7±69.2 mL, maximal axial diameter =40.1±8.1 mm, maximal orthogonal diameter =31.9+2.6 mm, P<0.05 for all comparisons), while FL decreased (pre-treatment: volume =129.6±150.5 mL; maximal axial diameter =43.0±15.8 mm; maximal orthogonal diameter =28.3±12.6 mm; follow-up: volume =66.6±95.0 mL, maximal axial diameter =24.5±19.9 mm, maximal orthogonal diameter =16.9±13.7, P<0.05 for all comparisons). Due to the uniformity in size throughout the vessel, high concordance was observed between diametric and volumetric measurements in the stented region with 93% and 92% between maximal axial diameter and volume for the true/false lumens, and 90% and 92% between maximal orthogonal diameter and volume for the true/false lumens. Large discrepancies were observed between the different measurement methods at regions distal to the stent graft, with up to 46% differences between maximal orthogonal diameter and volume. Conclusions Volume measurement was shown to be a much more sensitive indicator in identifying lumen expansion/shrinkage at the distal stented region.
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Affiliation(s)
- Wan Naimah Wan Ab Naim
- Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, 26600, Pekan, Pahang, Malaysia
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin University, Perth 6845, Australia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia
| | - Shirley Jansen
- Department of Vascular Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth WA 6009, Australia.,Curtin Medical School, Curtin University, Perth 6845, Australia.,University of Western Australia, Crawley WA 6009, Australia
| | - Jing Lei
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Poo Balan Ganesan
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Shahrul Amry Hashim
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | | | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
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14
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Md Idris N, Chiam YK, Varathan KD, Wan Ahmad WA, Chee KH, Liew YM. Feature selection and risk prediction for patients with coronary artery disease using data mining. Med Biol Eng Comput 2020; 58:3123-3140. [PMID: 33155096 DOI: 10.1007/s11517-020-02268-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Abstract
Coronary artery disease (CAD) is an important cause of mortality across the globe. Early risk prediction of CAD would be able to reduce the death rate by allowing early and targeted treatments. In healthcare, some studies applied data mining techniques and machine learning algorithms on the risk prediction of CAD using patient data collected by hospitals and medical centers. However, most of these studies used all the attributes in the datasets which might reduce the performance of prediction models due to data redundancy. The objective of this research is to identify significant features to build models for predicting the risk level of patients with CAD. In this research, significant features were selected using three methods (i.e., Chi-squared test, recursive feature elimination, and Embedded Decision Tree). Synthetic Minority Over-sampling Technique (SMOTE) oversampling technique was implemented to address the imbalanced dataset issue. The prediction models were built based on the identified significant features and eight machine learning algorithms, utilizing Acute Coronary Syndrome (ACS) datasets provided by National Cardiovascular Disease Database (NCVD) Malaysia. The prediction models were evaluated and compared using six performance evaluation metrics, and the top-performing models have achieved AUC more than 90%. Graphical abstract.
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Affiliation(s)
- Nashreen Md Idris
- Department of Software Engineering, Faculty of Computer Science and Information Technology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yin Kia Chiam
- Department of Software Engineering, Faculty of Computer Science and Information Technology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Kasturi Dewi Varathan
- Department of Information Systems, Faculty of Computer Science and Information Technology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- Department of Medicine, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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15
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Chuah SH, Md Sari NA, Chew BT, Tan LK, Chiam YK, Chan BT, Lim E, Abdul Aziz YF, Liew YM. Phenotyping of hypertensive heart disease and hypertrophic cardiomyopathy using personalized 3D modelling and cardiac cine MRI. Phys Med 2020; 78:137-149. [PMID: 33007738 DOI: 10.1016/j.ejmp.2020.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/08/2020] [Accepted: 08/30/2020] [Indexed: 12/24/2022] Open
Abstract
Differential diagnosis of hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) is clinically challenging but important for treatment management. This study aims to phenotype HHD and HCM in 3D + time domain by using a multiparametric motion-corrected personalized modeling algorithm and cardiac magnetic resonance (CMR). 44 CMR data, including 12 healthy, 16 HHD and 16 HCM cases, were examined. Multiple CMR phenotype data consisting of geometric and dynamic variables were extracted globally and regionally from the models over a full cardiac cycle for comparison against healthy models and clinical reports. Statistical classifications were used to identify the distinctive characteristics and disease subtypes with overlapping functional data, providing insights into the challenges for differential diagnosis of both types of disease. While HCM is characterized by localized extreme hypertrophy of the LV, wall thickening/contraction/strain was found to be normal and in sync, though it was occasionally exaggerated at normotrophic/less severely hypertrophic regions during systole to preserve the overall ejection fraction (EF) and systolic functionality. Additionally, we observed that hypertrophy in HHD could also be localized, although at less extreme conditions (i.e. more concentric). While fibrosis occurs mostly in those HCM cases with aortic obstruction, only minority of HHD patients were found affected by fibrosis. We demonstrate that subgroups of HHD (i.e. preserved and reduced EF: HHDpEF & HHDrEF) have different 3D + time CMR characteristics. While HHDpEF has cardiac functions in normal range, dilation and heart failure are indicated in HHDrEF as reflected by low LV wall thickening/contraction/strain and synchrony, as well as much reduced EF.
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Affiliation(s)
- Shoon Hui Chuah
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nor Ashikin Md Sari
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Bee Teng Chew
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yin Kia Chiam
- Department of Software Engineering, Faculty of Computer Science and Information Technology, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500 Semenyih, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia.
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16
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Leong CN, Dokos S, Andriyana A, Liew YM, Chan BT, Abdul Aziz YF, Chee KH, Sridhar GS, Lim E. The role of end-diastolic myocardial fibre stretch on infarct extension. Int J Numer Method Biomed Eng 2020; 36:e3291. [PMID: 31799767 DOI: 10.1002/cnm.3291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 10/11/2019] [Accepted: 11/20/2019] [Indexed: 06/10/2023]
Abstract
Myocardial infarct extension, a process involving the enlargement of infarct and border zone, leads to progressive degeneration of left ventricular (LV) function and eventually gives rise to heart failure. Despite carrying a high risk, the causation of infarct extension is still a subject of much speculation. In this study, patient-specific LV models were developed to investigate the correlation between infarct extension and impaired regional mechanics. Subsequently, sensitivity analysis was performed to examine the causal factors responsible for the impaired regional mechanics observed in regions surrounding the infarct and border zone. From our simulations, fibre strain, fibre stress and fibre stress-strain loop (FSSL) were the key biomechanical variables affected in these regions. Among these variables, only FSSL was correlated with infarct extension, as reflected in its work density dissipation (WDD) index value, with high WDD indices recorded at regions with infarct extension. Impaired FSSL is caused by inadequate contraction force generation during the isovolumic contraction and ejection phases. Our further analysis revealed that the inadequacy in contraction force generation is not necessarily due to impaired myocardial intrinsic contractility, but at least in part, due to inadequate muscle fibre stretch at end-diastole, which depresses the ability of myocardium to generate adequate contraction force in the subsequent systole (according to the Frank-Starling law). Moreover, an excessively stiff infarct may cause its neighbouring myocardium to be understretched at end-diastole, subsequently depressing the systolic contractile force of the neighbouring myocardium, which was found to be correlated with infarct extension.
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Affiliation(s)
- Chin Neng Leong
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Andri Andriyana
- Department of Mechanical Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Mechanical Engineering, UCSI University, Kuala Lumpur, Malaysia
| | | | - Kok-Han Chee
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Einly Lim
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
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17
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Leong CO, Leong CN, Abed AA, Ahmad Bakir A, Liew YM, Dokos S, Lim E. Computational Modelling of the Effect of Infarct Stiffness on Regional Myocardial Mechanics. Annu Int Conf IEEE Eng Med Biol Soc 2019; 2019:6952-6955. [PMID: 31947438 DOI: 10.1109/embc.2019.8856771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Ventricular remodeling after myocardial infarction increases the rate of mortality and is highly associated with the extent of infarct transmurality. It is hypothesized that infarct stiffness alters regional mechanics and affects the likelihood of human ventricular remodeling. However, this is yet to be studied in detail. In this paper, we present simulations from an actively-contracting left ventricular model to investigate the effects of transmural infarct stiffness on myofiber regional mechanics. Results show that higher infarct stiffness reduces systolic stress at the infarct and border zones, minimizing infarct bulging but increasing the diastolic stress at the endocardial border zone. Determining a proper amount of infarct stiffness is required to achieve a balanced regional mechanics across the cardiac cycle that may be useful in therapy, such as myocardial hydrogel injection to adjust its stiffness and reduce stress to prevent ventricular remodeling.
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18
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Khalid A, Lim E, Chan BT, Abdul Aziz YF, Chee KH, Yap HJ, Liew YM. Assessing regional left ventricular thickening dysfunction and dyssynchrony via personalized modeling and 3D wall thickness measurements for acute myocardial infarction. J Magn Reson Imaging 2019. [DOI: 10.1002/jmri.26719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Amirah Khalid
- Department of Biomedical Engineering, Faculty of EngineeringUniversity of Malaya Kuala Lumpur Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of EngineeringUniversity of Malaya Kuala Lumpur Malaysia
| | - Bee Ting Chan
- Department of Biomedical Engineering, Faculty of EngineeringUniversity of Malaya Kuala Lumpur Malaysia
| | - Yang Faridah Abdul Aziz
- University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine BuildingUniversity of Malaya Kuala Lumpur Malaysia
| | - Hwa Jen Yap
- Department of Mechanical Engineering, Faculty of EngineeringUniversity of Malaya Kuala Lumpur Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of EngineeringUniversity of Malaya Kuala Lumpur Malaysia
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19
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Habib M, Lee KM, Liew YM, Zakian C, Ung NM, Chew HP. Assessing surface characteristics of eroded dentine with optical coherence tomography: a preliminary in vitro validation study. Appl Opt 2018; 57:8673-8679. [PMID: 30461942 DOI: 10.1364/ao.57.008673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/13/2018] [Indexed: 06/09/2023]
Abstract
We conducted the first pilot study to investigate the use of the attenuation coefficient from an optical coherence tomography (OCT) backscattered signal as a measure of surface roughness changes in eroded dentine at an early stage of the erosion process. Ten human premolar root samples were subjected to citric acid treatment before scanning by OCT. The extracted relative attenuation coefficient (μR) from backscattered OCT signals was shown to increase with the duration of acid challenge. Validated against roughness measurements (rSa) from scanning electron microscopy scans, μR is significantly correlated with rSa indicative of severity of erosion (p<0.01, r=0.9195). We conclude that the OCT attenuation coefficient of the immediate subsurface in eroded dentine is a potential surrogate measure for its surface roughness. However, further work should be performed to study how it relates to the surface and immediate subsurface changes effected by other mechanical wear before it could unequivocally be used as a surrogate measurement for surface roughness.
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20
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Leong CO, Lim E, Tan LK, Abdul Aziz YF, Sridhar GS, Socrates D, Chee KH, Lee Z, Liew YM. Segmentation of left ventricle in late gadolinium enhanced MRI through 2D‐4D registration for infarct localization in 3D patient‐specific left ventricular model. Magn Reson Med 2018; 81:1385-1398. [DOI: 10.1002/mrm.27486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/30/2018] [Accepted: 07/15/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Chen Onn Leong
- Department of Biomedical Engineering, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- University Malaya Research Imaging Centre University of Malaya Kuala Lumpur Malaysia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- University Malaya Research Imaging Centre University of Malaya Kuala Lumpur Malaysia
| | | | - Dokos Socrates
- Department of Biomedical Engineering, Faculty of Engineering University of New South Wales Sydney NSW Australia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Zhen‐Vin Lee
- Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
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21
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Khalid A, Lim E, Chan BT, Abdul Aziz YF, Chee KH, Yap HJ, Liew YM. Assessing regional left ventricular thickening dysfunction and dyssynchrony via personalized modeling and 3D wall thickness measurements for acute myocardial infarction. J Magn Reson Imaging 2018; 49:1006-1019. [PMID: 30211445 DOI: 10.1002/jmri.26302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Existing clinical diagnostic and assessment methods could be improved to facilitate early detection and treatment of cardiac dysfunction associated with acute myocardial infarction (AMI) to reduce morbidity and mortality. PURPOSE To develop 3D personalized left ventricular (LV) models and thickening assessment framework for assessing regional wall thickening dysfunction and dyssynchrony in AMI patients. STUDY TYPE Retrospective study, diagnostic accuracy. SUBJECTS Forty-four subjects consisting of 15 healthy subjects and 29 AMI patients. FIELD STRENGTH/SEQUENCE 1.5T/steady-state free precession cine MRI scans; LGE MRI scans. ASSESSMENT Quantitative thickening measurements across all cardiac phases were correlated and validated against clinical evaluation of infarct transmurality by an experienced cardiac radiologist based on the American Heart Association (AHA) 17-segment model. STATISTICAL TEST Nonparametric 2-k related sample-based Kruskal-Wallis test; Mann-Whitney U-test; Pearson's correlation coefficient. RESULTS Healthy LV wall segments undergo significant wall thickening (P < 0.05) during ejection and have on average a thicker wall (8.73 ± 1.01 mm) compared with infarcted wall segments (2.86 ± 1.11 mm). Myocardium with thick infarct (ie, >50% transmurality) underwent remarkable wall thinning during contraction (thickening index [TI] = 1.46 ± 0.26 mm) as opposed to healthy myocardium (TI = 4.01 ± 1.04 mm). For AMI patients, LV that showed signs of thinning were found to be associated with a significantly higher percentage of dyssynchrony as compared with healthy subjects (dyssynchrony index [DI] = 15.0 ± 5.0% vs. 7.5 ± 2.0%, P < 0.01). Also, a strong correlation was found between our TI and left ventricular ejection fraction (LVEF) (r = 0.892, P < 0.01), and moderate correlation between DI and LVEF (r = 0.494, P < 0.01). DATA CONCLUSION The extracted regional wall thickening and DIs are shown to be strongly correlated with infarct severity, therefore suggestive of possible practical clinical utility. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1006-1019.
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Affiliation(s)
- Amirah Khalid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine Building, University of Malaya, Kuala Lumpur, Malaysia
| | - Hwa Jen Yap
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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22
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Khalil A, Ng SC, Liew YM, Lai KW. An Overview on Image Registration Techniques for Cardiac Diagnosis and Treatment. Cardiol Res Pract 2018; 2018:1437125. [PMID: 30159169 PMCID: PMC6109558 DOI: 10.1155/2018/1437125] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/05/2018] [Accepted: 07/17/2018] [Indexed: 12/13/2022] Open
Abstract
Image registration has been used for a wide variety of tasks within cardiovascular imaging. This study aims to provide an overview of the existing image registration methods to assist researchers and impart valuable resource for studying the existing methods or developing new methods and evaluation strategies for cardiac image registration. For the cardiac diagnosis and treatment strategy, image registration and fusion can provide complementary information to the physician by using the integrated image from these two modalities. This review also contains a description of various imaging techniques to provide an appreciation of the problems associated with implementing image registration, particularly for cardiac pathology intervention and treatments.
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Affiliation(s)
- Azira Khalil
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Faculty of Science and Technology, Islamic Science University of Malaysia, 71800 Nilai, Negeri Sembilan, Malaysia
| | - Siew-Cheok Ng
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Khin Wee Lai
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Tan LK, McLaughlin RA, Lim E, Abdul Aziz YF, Liew YM. Fully automated segmentation of the left ventricle in cine cardiac MRI using neural network regression. J Magn Reson Imaging 2018; 48:140-152. [PMID: 29316024 DOI: 10.1002/jmri.25932] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/04/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Left ventricle (LV) structure and functions are the primary assessment performed in most clinical cardiac MRI protocols. Fully automated LV segmentation might improve the efficiency and reproducibility of clinical assessment. PURPOSE To develop and validate a fully automated neural network regression-based algorithm for segmentation of the LV in cardiac MRI, with full coverage from apex to base across all cardiac phases, utilizing both short axis (SA) and long axis (LA) scans. STUDY TYPE Cross-sectional survey; diagnostic accuracy. SUBJECTS In all, 200 subjects with coronary artery diseases and regional wall motion abnormalities from the public 2011 Left Ventricle Segmentation Challenge (LVSC) database; 1140 subjects with a mix of normal and abnormal cardiac functions from the public Kaggle Second Annual Data Science Bowl database. FIELD STRENGTH/SEQUENCE 1.5T, steady-state free precession. ASSESSMENT Reference standard data generated by experienced cardiac radiologists. Quantitative measurement and comparison via Jaccard and Dice index, modified Hausdorff distance (MHD), and blood volume. STATISTICAL TESTS Paired t-tests compared to previous work. RESULTS Tested against the LVSC database, we obtained 0.77 ± 0.11 (Jaccard index) and 1.33 ± 0.71 mm (MHD), both metrics demonstrating statistically significant improvement (P < 0.001) compared to previous work. Tested against the Kaggle database, the signed difference in evaluated blood volume was +7.2 ± 13.0 mL and -19.8 ± 18.8 mL for the end-systolic (ES) and end-diastolic (ED) phases, respectively, with a statistically significant improvement (P < 0.001) for the ED phase. DATA CONCLUSION A fully automated LV segmentation algorithm was developed and validated against a diverse set of cardiac cine MRI data sourced from multiple imaging centers and scanner types. The strong performance overall is suggestive of practical clinical utility. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Robert A McLaughlin
- Australian Research Council Centre of Excellence for Nanoscale Biophotonics, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,Institute for Photonics and Advanced Sensing (IPAS), University of Adelaide, Adelaide, Australia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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Yong YL, Tan LK, McLaughlin RA, Chee KH, Liew YM. Linear-regression convolutional neural network for fully automated coronary lumen segmentation in intravascular optical coherence tomography. J Biomed Opt 2017; 22:1-9. [PMID: 29274144 DOI: 10.1117/1.jbo.22.12.126005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/01/2017] [Indexed: 05/13/2023]
Abstract
Intravascular optical coherence tomography (OCT) is an optical imaging modality commonly used in the assessment of coronary artery diseases during percutaneous coronary intervention. Manual segmentation to assess luminal stenosis from OCT pullback scans is challenging and time consuming. We propose a linear-regression convolutional neural network to automatically perform vessel lumen segmentation, parameterized in terms of radial distances from the catheter centroid in polar space. Benchmarked against gold-standard manual segmentation, our proposed algorithm achieves average locational accuracy of the vessel wall of 22 microns, and 0.985 and 0.970 in Dice coefficient and Jaccard similarity index, respectively. The average absolute error of luminal area estimation is 1.38%. The processing rate is 40.6 ms per image, suggesting the potential to be incorporated into a clinical workflow and to provide quantitative assessment of vessel lumen in an intraoperative time frame.
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Affiliation(s)
- Yan Ling Yong
- University of Malaya, Faculty of Engineering, Department of Biomedical Engineering, Kuala Lumpur, Malaysia
| | - Li Kuo Tan
- University of Malaya, Faculty of Medicine, Department of Biomedical Imaging, Kuala Lumpur, Malaysia
- University of Malaya, University Malaya Research Imaging Centre, Kuala Lumpur, Malaysia
| | - Robert A McLaughlin
- University of Adelaide, Faculty of Health and Medical Sciences, Adelaide Medical School, Australian, Australia
- University of Adelaide, Institute for Photonics and Advanced Sensing (IPAS), Adelaide, Australia
- University of Western Australia, School of Electrical, Electronic and Computer Engineering, Western, Australia
| | - Kok Han Chee
- University of Malaya, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- University of Malaya, Faculty of Engineering, Department of Biomedical Engineering, Kuala Lumpur, Malaysia
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Lanisa N, Chai HY, Cheok Ng S, Liew YM, Salim MIM, Lai KW. Texture Similarity Analysis of Breast Abnormalities in Infrared Thermal Image. j med imaging hlth inform 2017. [DOI: 10.1166/jmihi.2017.2264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tan LK, Liew YM, Lim E, Abdul Aziz YF, Chee KH, McLaughlin RA. Automatic localization of the left ventricular blood pool centroid in short axis cardiac cine MR images. Med Biol Eng Comput 2017; 56:1053-1062. [PMID: 29147835 DOI: 10.1007/s11517-017-1750-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
Abstract
In this paper, we develop and validate an open source, fully automatic algorithm to localize the left ventricular (LV) blood pool centroid in short axis cardiac cine MR images, enabling follow-on automated LV segmentation algorithms. The algorithm comprises four steps: (i) quantify motion to determine an initial region of interest surrounding the heart, (ii) identify potential 2D objects of interest using an intensity-based segmentation, (iii) assess contraction/expansion, circularity, and proximity to lung tissue to score all objects of interest in terms of their likelihood of constituting part of the LV, and (iv) aggregate the objects into connected groups and construct the final LV blood pool volume and centroid. This algorithm was tested against 1140 datasets from the Kaggle Second Annual Data Science Bowl, as well as 45 datasets from the STACOM 2009 Cardiac MR Left Ventricle Segmentation Challenge. Correct LV localization was confirmed in 97.3% of the datasets. The mean absolute error between the gold standard and localization centroids was 2.8 to 4.7 mm, or 12 to 22% of the average endocardial radius. Graphical abstract Fully automated localization of the left ventricular blood pool in short axis cardiac cine MR images.
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Affiliation(s)
- Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. .,University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia.
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Robert A McLaughlin
- Australian Research Council Centre of Excellence for Nanoscale Biophotonics, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,Institute for Photonics and Advanced Sensing, University of Adelaide, Adelaide, Australia.,School of Electrical, Electronic and Computer Engineering, University of Western Australia, Perth, Australia
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Khalil A, Faisal A, Ng SC, Liew YM, Lai KW. Multimodality registration of two-dimensional echocardiography and cardiac CT for mitral valve diagnosis and surgical planning. J Med Imaging (Bellingham) 2017; 4:037001. [PMID: 28840172 DOI: 10.1117/1.jmi.4.3.037001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/27/2017] [Indexed: 11/14/2022] Open
Abstract
A registration method to fuse two-dimensional (2-D) echocardiography images with cardiac computed tomography (CT) volume is presented. The method consists of two major procedures: temporal and spatial registrations. In temporal registration, the echocardiography frames at similar cardiac phases as the CT volume were interpolated based on electrocardiogram signal information, and the noise of the echocardiography image was reduced using the speckle reducing anisotropic diffusion technique. For spatial registration, an intensity-based normalized mutual information method was applied with a pattern search optimization algorithm to produce an interpolated cardiac CT image. The proposed registration framework does not require optical tracking information. Dice coefficient and Hausdorff distance for the left atrium assessments were [Formula: see text] and [Formula: see text], respectively; for left ventricle, they were [Formula: see text] and [Formula: see text], respectively. There was no significant difference in the mitral valve annulus diameter measurement between the manually and automatically registered CT images. The transformation parameters showed small deviations ([Formula: see text] deviation in translation and [Formula: see text] for rotation) between manual and automatic registrations. The proposed method aids the physician in diagnosing mitral valve disease as well as provides surgical guidance during the treatment procedure.
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Affiliation(s)
- Azira Khalil
- University of Malaya, Department of Biomedical Engineering, Faculty of Engineering, Kuala Lumpur, Malaysia.,Islamic Science University of Malaysia, Faculty of Science and Technology, Nilai, Negeri Sembilan, Malaysia
| | - Amir Faisal
- University of Malaya, Department of Biomedical Engineering, Faculty of Engineering, Kuala Lumpur, Malaysia
| | - Siew-Cheok Ng
- University of Malaya, Department of Biomedical Engineering, Faculty of Engineering, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- University of Malaya, Department of Biomedical Engineering, Faculty of Engineering, Kuala Lumpur, Malaysia
| | - Khin Wee Lai
- University of Malaya, Department of Biomedical Engineering, Faculty of Engineering, Kuala Lumpur, Malaysia
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Tan LK, Liew YM, Lim E, McLaughlin RA. Convolutional neural network regression for short-axis left ventricle segmentation in cardiac cine MR sequences. Med Image Anal 2017; 39:78-86. [DOI: 10.1016/j.media.2017.04.002] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 04/04/2017] [Accepted: 04/11/2017] [Indexed: 11/24/2022]
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Chan BT, Yeoh HK, Liew YM, Aziz YFA, Sridhar GS, Hamilton-Craig C, Platts D, Lim E. Left ventricular flow propagation velocity measurement: Is it cast in stone? Med Biol Eng Comput 2017; 55:1883-1893. [PMID: 28321684 DOI: 10.1007/s11517-017-1639-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
This study aims to investigate the measurement of left ventricular flow propagation velocity, V p, using phase contrast magnetic resonance imaging and to assess the discrepancies resulting from inflow jet direction and individual left ventricular size. Three V p measuring techniques, namely non-adaptive (NA), adaptive positions (AP) and adaptive vectors (AV) method, were suggested and compared. We performed the comparison on nine healthy volunteers and nine post-infarct patients at four measurement positions, respectively, at one-third, one-half, two-thirds and the conventional 4 cm distances from the mitral valve leaflet into the left ventricle. We found that the V p measurement was affected by both the inflow jet direction and measurement positions. Both NA and AP methods overestimated V p, especially in dilated left ventricles, while the AV method showed the strongest correlation with the isovolumic relaxation myocardial strain rate (r = 0.53, p < 0.05). Using the AV method, notable difference in mean V p was also observed between healthy volunteers and post-infarct patients at positions of: one-half (81 ± 31 vs. 58 ± 25 cm/s), two-thirds (89 ± 32 vs. 45 ± 15 cm/s) and 4 cm (98 ± 23 vs. 47 ± 13 cm/s) distances. The use of AV method and measurement position at one-half distance was found to be the most suitable method for assessing diastolic dysfunction given varying left ventricular sizes and inflow jet directions.
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Affiliation(s)
- Bee Ting Chan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hak Koon Yeoh
- Department of Chemical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Seri Kembangan Engineering Sdn. Bhd., 61-1, Jalan Anggerik Vanilla T, Kota Kemuning, 40460, Shah Alam, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | | | - Christian Hamilton-Craig
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, 4006, Australia
| | - David Platts
- School of Medicine, University of Queensland, Brisbane, QLD, 4006, Australia.,Department of Echocardiography, The Prince Charles Hospital, Chermside, QLD, 4032, Australia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Khalil A, Faisal A, Lai KW, Ng SC, Liew YM. 2D to 3D fusion of echocardiography and cardiac CT for TAVR and TAVI image guidance. Med Biol Eng Comput 2016; 55:1317-1326. [PMID: 27830464 DOI: 10.1007/s11517-016-1594-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
Abstract
This study proposed a registration framework to fuse 2D echocardiography images of the aortic valve with preoperative cardiac CT volume. The registration facilitates the fusion of CT and echocardiography to aid the diagnosis of aortic valve diseases and provide surgical guidance during transcatheter aortic valve replacement and implantation. The image registration framework consists of two major steps: temporal synchronization and spatial registration. Temporal synchronization allows time stamping of echocardiography time series data to identify frames that are at similar cardiac phase as the CT volume. Spatial registration is an intensity-based normalized mutual information method applied with pattern search optimization algorithm to produce an interpolated cardiac CT image that matches the echocardiography image. Our proposed registration method has been applied on the short-axis "Mercedes Benz" sign view of the aortic valve and long-axis parasternal view of echocardiography images from ten patients. The accuracy of our fully automated registration method was 0.81 ± 0.08 and 1.30 ± 0.13 mm in terms of Dice coefficient and Hausdorff distance for short-axis aortic valve view registration, whereas for long-axis parasternal view registration it was 0.79 ± 0.02 and 1.19 ± 0.11 mm, respectively. This accuracy is comparable to gold standard manual registration by expert. There was no significant difference in aortic annulus diameter measurement between the automatically and manually registered CT images. Without the use of optical tracking, we have shown the applicability of this technique for effective fusion of echocardiography with preoperative CT volume to potentially facilitate catheter-based surgery.
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Affiliation(s)
- Azira Khalil
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Amir Faisal
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Khin Wee Lai
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Siew Cheok Ng
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Leong CO, Liew YM, Bilgen M, Abdul Aziz YF, Chee KH, Chiam YK, Lim E. Assessment of infarct-specific cardiac motion dysfunction using modeling and multimodal magnetic resonance merging. J Magn Reson Imaging 2016; 45:525-534. [DOI: 10.1002/jmri.25390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/30/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Chen Onn Leong
- Department of Biomedical Engineering; Faculty of Engineering, University of Malaya; Kuala Lumpur Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering; Faculty of Engineering, University of Malaya; Kuala Lumpur Malaysia
| | - Mehmet Bilgen
- Biophysics Department; Faculty of Medicine, Adnan Menderes University; Aydin Turkey
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging; University Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya; Kuala Lumpur Malaysia
| | - Kok Han Chee
- Department of Medicine; Faculty of Medicine, University of Malaya; Kuala Lumpur Malaysia
| | - Yin Kia Chiam
- Department of Software Engineering; Faculty of Computer Science & Information Technology, University of Malaya; Kuala Lumpur Malaysia
| | - Einly Lim
- Department of Biomedical Engineering; Faculty of Engineering, University of Malaya; Kuala Lumpur Malaysia
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Jahanzad Z, Liew YM, Bilgen M, McLaughlin RA, Leong CO, Chee KH, Aziz YFA, Ung NM, Lai KW, Ng SC, Lim E. Regional assessment of LV wall in infarcted heart using tagged MRI and cardiac modelling. Phys Med Biol 2015; 60:4015-31. [DOI: 10.1088/0031-9155/60/10/4015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Liew YM, McLaughlin RA, Chan BT, Aziz YFA, Chee KH, Ung NM, Tan LK, Lai KW, Ng S, Lim E. Motion corrected LV quantification based on 3D modelling for improved functional assessment in cardiac MRI. Phys Med Biol 2015; 60:2715-33. [DOI: 10.1088/0031-9155/60/7/2715] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gong P, Chin L, Es'haghian S, Liew YM, Wood FM, Sampson DD, McLaughlin RA. Imaging of skin birefringence for human scar assessment using polarization-sensitive optical coherence tomography aided by vascular masking. J Biomed Opt 2014; 19:126014. [PMID: 25539060 DOI: 10.1117/1.jbo.19.12.126014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/03/2014] [Indexed: 05/18/2023]
Abstract
We demonstrate the in vivo assessment of human scars by parametric imaging of birefringence using polarization-sensitive optical coherence tomography (PS-OCT). Such in vivo assessment is subject to artifacts in the detected birefringence caused by scattering from blood vessels. To reduce these artifacts, we preprocessed the PS-OCT data using a vascular masking technique. The birefringence of the remaining tissue regions was then automatically quantified. Results from the scars and contralateral or adjacent normal skin of 13 patients show a correspondence of birefringence with scar type: the ratio of birefringence of hypertrophic scars to corresponding normal skin is 2.2 ± 0.2 (mean ± standard deviation ), while the ratio of birefringence of normotrophic scars to normal skin is 1.1 ± 0.4 . This method represents a new clinically applicable means for objective, quantitative human scar assessment.
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Affiliation(s)
- Peijun Gong
- The University of Western Australia, School of Electrical, Electronic and Computer Engineering, Optical+Biomedical Engineering Laboratory, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Lixin Chin
- The University of Western Australia, School of Electrical, Electronic and Computer Engineering, Optical+Biomedical Engineering Laboratory, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Shaghayegh Es'haghian
- The University of Western Australia, School of Electrical, Electronic and Computer Engineering, Optical+Biomedical Engineering Laboratory, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Yih Miin Liew
- University of Malaya, Faculty of Engineering, Department of Biomedical Engineering, Kuala Lumpur 50603, Malaysia
| | - Fiona M Wood
- Royal Perth Hospital, Burns Service of Western Australia, Wellington Street, Perth, Western Australia 6000, AustraliadThe University of Western Australia, School of Surgery, Burn Injury Research Unit, 35 Stirling Highway, Crawley, Western Australia 6009
| | - David D Sampson
- The University of Western Australia, School of Electrical, Electronic and Computer Engineering, Optical+Biomedical Engineering Laboratory, 35 Stirling Highway, Crawley, Western Australia 6009, AustraliaeThe University of Western Australia, Centre for Micr
| | - Robert A McLaughlin
- The University of Western Australia, School of Electrical, Electronic and Computer Engineering, Optical+Biomedical Engineering Laboratory, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
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Hossain MB, Lai KW, Pingguan-Murphy B, Hum YC, Mohd Salim MI, Liew YM. Contrast enhancement of ultrasound imaging of the knee joint cartilage for early detection of knee osteoarthritis. Biomed Signal Process Control 2014. [DOI: 10.1016/j.bspc.2014.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gong P, McLaughlin RA, Liew YM, Munro PRT, Wood FM, Sampson DD. Assessment of human burn scars with optical coherence tomography by imaging the attenuation coefficient of tissue after vascular masking. J Biomed Opt 2014; 19:21111. [PMID: 24192908 DOI: 10.1117/1.jbo.19.2.021111] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 09/20/2013] [Indexed: 05/19/2023]
Abstract
The formation of burn-scar tissue in human skin profoundly alters, among other things, the structure of the dermis. We present a method to characterize dermal scar tissue by the measurement of the near-infrared attenuation coefficient using optical coherence tomography (OCT). To generate accurate en face parametric images of attenuation, we found it critical to first identify (using speckle decorrelation) and mask the tissue vasculature from the three-dimensional OCT data. The resulting attenuation coefficients in the vasculature-masked regions of the dermis of human burn-scar patients are lower in hypertrophic (3.8±0.4 mm(-1)) and normotrophic (4.2±0.9 mm(-1)) scars than in contralateral or adjacent normal skin (6.3±0.5 mm(-1)). Our results suggest that the attenuation coefficient of vasculature-masked tissue could be used as an objective means to assess human burn scars.
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Affiliation(s)
- Peijun Gong
- The University of Western Australia, School of Electrical, Electronic and Computer Engineering, Optical + Biomedical Engineering Laboratory, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
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Liew YM, McLaughlin RA, Gong P, Wood FM, Sampson DD. In vivo assessment of human burn scars through automated quantification of vascularity using optical coherence tomography. J Biomed Opt 2013; 18:061213. [PMID: 23174911 DOI: 10.1117/1.jbo.18.6.061213] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In scars arising from burns, objective assessment of vascularity is important in the early identification of pathological scarring, and in the assessment of progression and treatment response. We demonstrate the first clinical assessment and automated quantification of vascularity in cutaneous burn scars of human patients in vivo that uses optical coherence tomography (OCT). Scar microvasculature was delineated in three-dimensional OCT images using speckle decorrelation. The diameter and area density of blood vessels were automatically quantified. A substantial increase was observed in the measured density of vasculature in hypertrophic scar tissues (38%) when compared against normal, unscarred skin (22%). A proliferation of larger vessels (diameter≥100 μm) was revealed in hypertrophic scarring, which was absent from normal scars and normal skin over the investigated physical depth range of 600 μm. This study establishes the feasibility of this methodology as a means of clinical monitoring of scar progression.
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Affiliation(s)
- Yih Miin Liew
- The University of Western Australia, School of Electrical, Electronic & Computer Engineering, Optical and Biomedical Engineering Laboratory, Crawley, Perth, Australia.
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Liew YM, McLaughlin RA, Wood FM, Sampson DD. Motion correction of in vivo three-dimensional optical coherence tomography of human skin using a fiducial marker. Biomed Opt Express 2012; 3:1774-86. [PMID: 22876343 PMCID: PMC3409698 DOI: 10.1364/boe.3.001774] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 06/21/2012] [Accepted: 06/26/2012] [Indexed: 05/04/2023]
Abstract
This paper presents a novel method based on a fiducial marker for correction of motion artifacts in 3D, in vivo, optical coherence tomography (OCT) scans of human skin and skin scars. The efficacy of this method was compared against a standard cross-correlation intensity-based registration method. With a fiducial marker adhered to the skin, OCT scans were acquired using two imaging protocols: direct imaging from air into tissue; and imaging through ultrasound gel into tissue, which minimized the refractive index mismatch at the tissue surface. The registration methods were assessed with data from both imaging protocols and showed reduced distortion of skin features due to motion. The fiducial-based method was found to be more accurate and robust, with an average RMS error below 20 µm and success rate above 90%. In contrast, the intensity-based method had an average RMS error ranging from 36 to 45 µm, and a success rate from 50% to 86%. The intensity-based algorithm was found to be particularly confounded by corrugations in the skin. By contrast, tissue features did not affect the fiducial-based method, as the motion correction was based on delineation of the flat fiducial marker. The average computation time for the fiducial-based algorithm was approximately 21 times less than for the intensity-based algorithm.
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Affiliation(s)
- Yih Miin Liew
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, M018, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Robert A. McLaughlin
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, M018, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Fiona M. Wood
- Burns Service of Western Australia, Royal Perth Hospital (RPH), Wellington Street, Perth WA 6000, Australia
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - David D. Sampson
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, M018, 35 Stirling Highway, Crawley WA 6009, Australia
- Centre for Microscopy, Characterisation & Analysis, The University of Western Australia, M010, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
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Liew YM, McLaughlin RA, Wood FM, Sampson DD. Reduction of image artifacts in three-dimensional optical coherence tomography of skin in vivo. J Biomed Opt 2011; 16:116018. [PMID: 22112123 DOI: 10.1117/1.3652710] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This paper presents results of in vivo studies on the effect of refractive index-matching media on image artifacts in optical coherence tomography (OCT) images of human skin. These artifacts present as streaks of artificially low backscatter and displacement or distortion of features. They are primarily caused by refraction and scattering of the OCT light beam at the skin surface. The impact of the application of glycerol and ultrasound gel is assessed on both novel skin-mimicking phantoms and in vivo human skin, including assessment of the epidermal thickening caused by the media. Based on our findings, recommendations are given for optimal OCT imaging of skin in vivo.
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Affiliation(s)
- Yih Miin Liew
- The University of Western Australia, School of Electrical, Electronic & Computer Engineering, Crawley, WA 6009, Australia.
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Abstract
In Western countries, it has been shown that coronary heart disease (CHD) is related to high serum total cholesterol (TC) levels. In less developed continents such as Asia and Africa, serum lipid levels are low and CHD incidence is much lower as compared with Western countries. With growing urbanization and industrialization in Asia, it has been shown that there is a concomitant rise in the level of serum TC and with it a rise in CHD. In all the Asian countries, serum TC levels are also higher in the urban compared with the rural population. Singapore, the only Asian country which is 100% urbanized since 1980, showed a rise of serum TC similar to that seen in the US and UK from the 1950s to the 1980s followed thereafter by a fall. This is reflected in the trend (rise followed by a fall) of CHD morbidity and mortality as well. In spite of a declining trend in serum TC level, CHD morbidity and mortality are still high in Singapore and comparable to the Western countries. The rest of the Asian countries show a different pattern from Singapore. In general, there is still a rising trend in serum TC level and in CHD mortality in most Asian countries. However, Japan is considered an exception in having a decreasing CHD mortality in spite of an increasing trend in serum TC. This may be attributed to a better control of other CHD risk factors such as hypertension and smoking. The rising trend in serum TC level remains a cause for concern, as this will emerge as a major problem for CHD morbidity and mortality in the future.
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Affiliation(s)
- K L Khoo
- Heart Foundation of Malaysia (Yayasan Jantung Malaysia), 35 Jalan Kia Peng, 50450, Kuala Lumpur, Malaysia
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Khoo KL, Tan H, Liew YM, Sambhi JS, Aljafri AM, Hatijah A. Blood pressure, body mass index, heart rate and levels of blood cholesterol and glucose of volunteers during National Heart Weeks, 1995-1997. Med J Malaysia 2000; 55:439-50. [PMID: 11221155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The paper presents the results of a health screening programme conducted in 10 major centers in Malaysia--Kuala Lumpur, Penang, Ipoh, Johor Bahru, Alor Star, Kuala Terengganu, Malacca, Kota Bahru, Kuching and Kota Kinabalu during the National Heart Weeks, 1995-1997. There were 6,858 participants of both sexes aged between 6 years to 81 years old. The parameters involved in the screening programme were body mass index, blood pressure, heart rate, cholesterol and glucose. The following are the results of the study:- 1. The mean and standard deviation for the body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), total cholesterol (TC) and non fasting (random) blood glucose (GL) of the volunteers studied were 24.3 +/- 4.0 kg/m2, 128.3 +/- 21.1 mmHg, 79.6 +/- 11.9 mmHg, 77.2 +/- 12.1 bpm, 5.33 +/- 1.37 mmol/l and 5.11 +/- 1.97 mmol/l respectively. 2. There was a rising trend for BMI, SBP, DBP, TC and GL with age. The HR was higher in the younger age group of those below 20 years. Males tended to have higher mean values than females except for HR which was similar in both sexes. 3. The Malays, Chinese and Indians seemed to have closely similar mean values for SBP, DBP and HR but the Indians possessed the highest BMI (25.62 +/- 3.90 kg/m2), TC (5.61 +/- 1.48 mmol/l) and GL (5.41 +/- 2.43 mmol/l) among the three major ethnic groups. While the Ibans had highest TC (6.07 + 1.09 mmol/l), their GL level was the lowest (4.76 +/- 1.15 mmol/l). The Kadazans had the lowest TC level (4.94 +/- 1.39 mmol/l) among all the ethnic groups. 4. Among the participants screened, 31.9% were overweight (BMI > or = 25), 7.6% were obese (BMI > or = 30); 26.8% had raised SBP (> or = 140 mmHg) and 19.3% had raised DBP (> or = 90 mmHg); 13.6% of the participants had increased HR (> or = 90 bpm), 22% had raised TC (> or = 6.20 mmol/l) and 2% had raised GL (> or = 11.00 mmol/l). There was a higher prevalence for abnormal values with increasing age until between the ages of 60 or 70 years, when the values began to fall. 5. Age was positively correlated with SBP (r = 0.41***, df = 4351), DBP (r = 0.27***, df = 4351), TC (r = 0.22***, df = 3303) and GL (r = 0.16***, df = 2442) but negatively correlated with HR (r = -0.13***, df = 4351). The BMI was positively correlated with SBP (r = 0.29***, df = 2769), DBP (r = 0.31***, df = 2769), TC (r = 0.16***, df = 2137) and GL (r = 0.11**, df = 1637) but there was no correlation with HR (r = 0.03NS, df = 2771). The SBP and DBP were highly correlated with each other (r = 0.75***, df = 4351) and they also showed highly significant positive correlation (r = 0.08***-0.13***, df = 2441-3301) with TC and GL. TC was positively correlated with GL (r = 0.05* df = 2319) but only at the 5% probability level.
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Affiliation(s)
- K L Khoo
- Heart Foundation Malaysia (Yayasan Jantung Malaysia), 35 Jalan Kia Peng, 50450 Kuala Lumpur
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Khoo KL, Tan H, Liew YM. Familial hyperlipidaemia in Malaysian children. Med J Malaysia 2000; 55:249-258. [PMID: 19839155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper highlights two cases of paediatric familial hyperlipidaemia (hypercholesterolaemia and hypertriglyceridaemia). The first case was an 11 year old Chinese boy, a "homozygous" (Type II) hypercholesterolaemic patient. He had extremely high blood cholesterol level (19.4 mmol/l), severe multiple xanthoma and abnormal resting electrocardiogram. He had repeated heart attacks and died at the age of 15 in spite of early intervention, treatment and follow up. The second case was a 2 1/2 years old girl who had severe hypertriglyceridaemia. She had raised cholesterol (6.2 mmol/l) and extremely high triglycerides (14.8 mmol/l). The patient did not resemble Type I lipoproteinaemia which is classically seen in childhood. On the contrary, the patient exhibited clinical and biochemical manifestations of a Type V lipoproteinaemia which often occurs in adults. Apart from a Type V lipoprotein pattern, the patient had low post hepatic lipase activity (PHLA), Apo C II and Apo E2/E3 phenotype. In addition, the lipid profile of her family members (both the parents and brothers) had raised triglycerides and thus ruled out the Type I lipoprotein inheritance pattern, which is an autosomal recessive condition. The issue of paediatric hyperlipidaemia, their management and treatments are discussed.
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Affiliation(s)
- K L Khoo
- Klinik Dr Khoo Kah Lin, 25, Jalan Medan Tuanku, 50300 Kuala Lumpur
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Khoo KL, Liew YM, Tan H, Sambhi JS, Hatijah BA. Patients' knowledge and attitude towards treatment and control of hypertension: a nation-wide telephone survey conducted in Malaysia. Med J Malaysia 1999; 54:37-46. [PMID: 10972003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The telephone survey of 2,526 hypertensive subjects showed 94% of the respondents were aware of the importance in controlling hypertension. Among these 504 were not on anti-hypertensive medication while the majority of 2,022 were currently on anti-hypertensive medication. Of those who were not on medication, 80% (n = 403) were found non-hypertensive on follow-up. The remaining 20% (n = 101) were confirmed hypertensive and were offered medication. However, 38 subjects refused to take medication and 63 subjects complied with medication but subsequently gave up. The main reasons for giving up medication included lack of motivation (38%), doctors' advice (20%), side effects (19%) and concern of side effects (10%). Of 2,022 hypertensive respondents who were currently on medication, almost half (44%, n = 890) required a change of medication due to side effects (40%, n = 356) or the blood pressure not controlled with the previous medication (33%, n = 294). Despite the change in medication, 42% (n = 150) still continued to suffer from some form of side effects. The information obtained from this survey suggested it is important to recommend some strategies to improve patient compliance. These strategies comprise of motivating the patient, improving medication with less side effects, improving potency and efficiency of medication, and reduction of cost in medication. In addition, convenient blood pressure monitoring such as home blood pressure monitoring is also encouraged.
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Affiliation(s)
- K L Khoo
- Heart Foundation of Malaysia, Jalan Kia Peng, Kuala Lumpur
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Liew YM, Zulkifli A, Tan H, Ho YN, Khoo KL. Health status of senior civil servants in Kuala Lumpur. Med J Malaysia 1997; 52:348-66. [PMID: 10968112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
733 senior civil servants comprising 520 males and 213 females with a mean age of 44 years (range 25-56 years) were screened for their health status. The sample population comprised of 67.9% Malays, 22.5% Chinese, 9.1% Indians and 0.4% other ethnic origins. The subjects' medical histories were recorded and a full medical examination including anthropometric measurements (weight, height, waist and hip circumference), blood biochemistry and urine analysis, chest X-ray and electrocardiograms were done. The results obtained showed that 36.0% of the study population were overweight with 6.5% being obese. Of this 32.0% had central obesity. 15.2% of the subjects had systolic hypertension (systolic BP > or = 140 mmHg) whilst 27.6% had diastolic hypertension (diastolic BP > or = 90 mmHg). Hyperlipidaemia was common, with 75.2% subjects having raised cholesterol, 19.9% raised triglycerides, 50.2% raised LDL-C, 74.6% raised TC:HDL-C and 26.6% raised LDL:HDL-C. An elevated blood glucose was found in 8.4% subjects, whilst urine sugar was detected in only 2.6%, and a raised uric acid was found in 2.8% subjects. The prevalence of hypertension, raised blood glucose and hyperlipidaemia increased with age with more males affected than females. Although hypercholesterolaemia appeared more frequently amongst the Malays, the Indians, by comparison had the highest prevalence for a raised LDL:HDL-C ratio, a reflection of the increase in LDL-C and a concomitant decrease in HDL-C. The latter findings indicate that the Indians are at greater risk for the development of coronary heart disease than the Chinese and Malays. In addition, the mean levels of serum cholesterol found in this study seemed to have exceeded the levels found in populations in the industrialised countries such as the USA. There is thus an urgent need for more public health campaigns aimed at the reduction and control of such coronary risk factors.
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Khoo KL, Tan H, Liew YM. Serum lipids and their relationship with other coronary risk factors in healthy subjects in a city clinic. Med J Malaysia 1997; 52:38-52. [PMID: 10968052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Over a thousand subjects who visited a city private medical clinic for health screening and advice were examined for their lipid profile and other cardiovascular risk factors. The mean TC, TG, LDL-C and HDL-C were 5.43, 1.45, 3.61 and 1.15 mmol/l. Their derived ratios viz, TC:HDL-C and LDL:HDL-C were 5.11 and 3.43 respectively. The prevalence of hyperlipidaemia was moderately high. Of the subjects studied 58.5% had elevated serum cholesterol, 14.8% had raised triglycerides, 64.9% had raised LDL-C and 20.8% had low HDL-C. Male subjects generally showed higher mean values and abnormality frequency in TC, TG, LDL-C, TC:HDL-C and LDL:HDL-C as compared to female subjects. Although significant ethnic differences were not detected for certain lipid parameters (e.g. TC, TG and HDL-C), the Indians appeared to have higher mean lipid values (except HDL-C), and higher percentage abnormality for all the lipid parameters as compared to the Chinese and the Malays. In correlation studies, the following lipid parameters:- TC versus TG, LDL-C, TC:HDL-C; TG versus TC:HDL-C and LDL:HDL-C; LDL-C versus TC:HDL-C and LDL:HDL-C; were positively correlated. On the other hand, TC versus HDL-C, TG versus HDL-C, LDL-C and HDL-C, and HDL-C versus TC:HDL-C and LDL:HDL-C were negatively correlated. The coronary risk factors which generally showed positive correlations with lipid parameters were BMI and blood pressure. Positive correlations were also recorded between fasting blood glucose and TG; uric acid with TG, TC:HDL-C and LDL:HDL-C. In contrast, risk factors of negative correlations were observed between HDL-C and the coronary risk factors of BMI, diastolic blood pressure and uric acid. Smoking showed raised per cent lipid abnormality for TG, HDL-C, TC:HDL-C and LDL:HDL-C. Alcohol consumption also increased the mean level and abnormality frequency for TG. The implication of this investigation is discussed.
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Affiliation(s)
- K L Khoo
- Pantai Medical Centre, Kuala Lumpur
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Liew YM, Chia J, Low YP. Delayed abscess formation in the wrist due to an unusual retained foreign body--a case report. Ann Acad Med Singap 1995; 24:867-8. [PMID: 8838998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It is well documented that retained foreign bodies can be associated with delayed abscess formation in the body. We report an unusual case of a large bomb shrapnel in the wrist of a 64-year-old Chinese woman which was retained for 52 years, causing gross wrist destruction and delayed abscess formation. An open drainage of the wrist abscess was done and the shrapnel was removed. A secondary closure was subsequently done but the patient refused another procedure for a formal wrist arthrodesis.
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Affiliation(s)
- Y M Liew
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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